Provider Demographics
NPI:1467534669
Name:ALLICK, ALBERT P (MD)
Entity Type:Individual
Prefix:
First Name:ALBERT
Middle Name:P
Last Name:ALLICK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3220 18TH ST S # SUOTE7
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-6564
Mailing Address - Country:US
Mailing Address - Phone:701-970-0542
Mailing Address - Fax:
Practice Address - Street 1:3220 18TH ST S STE 7
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-6564
Practice Address - Country:US
Practice Address - Phone:701-970-0542
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND98242084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN240206Medicare Oscar/Certification